Healthcare Provider Details

I. General information

NPI: 1376922377
Provider Name (Legal Business Name): DR ANDRES MIGUEL PEREIRA M.D.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 SICKLES ST OFC 1A
NEW YORK NY
10040-1604
US

IV. Provider business mailing address

47 SICKLES ST OFC 1A
NEW YORK NY
10040-1604
US

V. Phone/Fax

Practice location:
  • Phone: 212-567-6200
  • Fax: 212-567-9397
Mailing address:
  • Phone: 212-567-6200
  • Fax: 212-567-9397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDRES MIGUEL PEREIRA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 212-567-6200